…Flow Stung by the Ebb
Walt Whitman, The Body Electric (circa 1855)
Whitman celebrated the beauty of the female form in verse by the famous line, “Ebb stung by the flow and flow stung by the ebb.”. Viewed differently, his words may offer an apt description for the condition of lymphedema.
Lymphedema is a disease that involves the swelling of arms or legs. It is most commonly caused by removal of lymph nodes during surgery for cancer of the breast or female reproductive organs. In fact, it is estimated that there are 200,000 new cases of lymphedema each year in the United States, making it one of the most common long term surgical complications.
Lymph is the protein rich fluid (Interstitial Fluid) that circulates through our bodies helping fight infections and returning nutrients to the bloodstream. It is carried by specialized vessels called lymphatics and filtered at various points in the body by lymph nodes. When a cancer is present, the cancerous cells travel to distant sites by hitching a ride on the lymphatic system. Assessing Lymph Nodes, in cases of cancer, determines the extent of spread (stage) and selective removal of nodes is part of the cure.
Unfortunately, removal of lymph nodes and lymphatics sometimes disrupts (ebb) normal lymph flow. Lymphatic injury presents as swollen arms or legs or lymphedema. Lymphedema of an extremity causes a number of distressing problems such as swelling (elephantiasis); skin changes; decreased function; ulceration; and infections. Needless to say, these changes profoundly impact the quality of life of cancer survivors.
A separate group of patients, the morbidly obese, are sometimes afflicted with swelling of the legs, known as Lipoedema. This condition is similar to lymphedema, but there is no surgical disruption of the lymphatic system. It is believed to be result of fat cells being constantly exposed to leaked lymphatic fluids.
Lymphedema continues to be a vexing problem that frustrates providers and patients alike. In the past, treatment of lymphedema meant a lifelong commitment to customized compression garments and physical therapy. While effective in improving symptoms and Quality of Life (QoL), the garments themselves are unwieldy and require constant application.
Fortunately, in the past decade, Plastic Surgeons have made substantial improvements in the treatment of lymphedema. The sub-specialty of Microsurgery has allowed for advances in the treatment of lymphedema. My former Chairman at McGill University, Dr. H. Bruce Williams, was one of the founders of the International Microsurgery Society. Using Microsurgical techniques, Japanese surgeons were able to improve swelling of the arms and legs by creating multiple microsurgical bypasses along the limb (LVA). The vessels bypassed are a few millimeters in diameter and require sutures far thinner than a human hair. In order to perform the surgery, a microscope providing magnification of upto 25-times is necessary. Other techniques involve transferring healthy Lymph Nodes to replace the damaged lymphatic channels (FLNT). In the case of obesity related lipoedema, debulking the limb with liposuction has proven effective (MITE).
I continue to be optimistic and impressed with the rapid pace with which lymphedema treatment is progressing. While we do not pretend to offer a “cure” for lymphedema, substantial improvements in the condition and quality of life are possible.
It is also encouraging to note legislative actions supporting treatment of lymphedema in the form of the Lymphedema Treatment Act are presently before Congress.
If you or a loved one suffer from lymphedema, I encourage you contact your State Representative to voice your support for the Lymphedema Treatment Act.
This blog is a brief description of a highly technical subject and complex disease process. The discussion is necessarily brief. If you’d like to learn more, please contact our practice for information on surgical treatments of lymphedema.
Dr. Pravin Reddy is a Board Certified Plastic and Reconstructive Surgeon. He received additional training in Microsurgery in New York, NY. He has performed hundreds of Microsurgical cases for trauma and cancer patients.
P. Pravin Reddy, MD is a Board Certified Plastic & Reconstructive Surgeon and a member of the American Society of Plastic Surgeons.